The relationship between mental illness severity and stigma

OBJECTIVE: To investigate influencing factors for lay perception of mental illness severity and their effects on the stigma of mental illness. METHOD: Selective review including attitude surveys assessing social distance towards different diagnostic labels, and attitudes towards treatment professions, treatment strategies, and psychopharmacotherapy. RESULTS: Lays differentiate in their attitudes towards people with mental illness according to the given diagnostic label, the involved treatment professions or institutions, the applied treatment methods, and the perceived psychosocial disability. CONCLUSION: Beside perceived treatment intensity and diagnostic label, the perception of social disability of mentally ill people accounts for a differentiated stigma. The question arises how anti-stigma-programmes can include the topic of social disability into their messages without risking to strengthen the stigma of mental illness.     

Distinguishing illness severity from tic severity in children and adolescents with Tourette's disorder

OBJECTIVE: To examine whether tic severity, comorbid disorders, or both are associated with illness morbidity in youths with Tourette's disorder (TD). METHOD: Subjects were 156 consecutively referred youths (aged 5-20 years) who met DSM-III-R criteria for Tourette's disorder at a major academic medical center. All subjects were evaluated with a clinical interview by a child and adolescent psychiatrist and an assessment battery that included the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Epidemiologic version. Statistical analysis used chi 2 and multivariate logistic regression. RESULTS: Nineteen (12%) of the 156 youths with TD required psychiatric hospitalization. Current age, TD severity, TD duration, obsessive-compulsive disorder, psychosis, major depression, bipolar disorder, panic disorder, and overanxious disorder were significant univariate predictors of psychiatric hospitalization (p < .01). While tic severity was marginally significant as a predictor of psychiatric hospitalization (p < .05), major depression (p < .016) and bipolar disorder (p < .001) were robust predictors of psychiatric hospitalization, even after statistical adjustment for collinearity and correction for all other variables assessed. CONCLUSION: The findings indicate that comorbid mood disorders are strongly associated with illness morbidity in youths with TD, highlighting the importance of attention to comorbidity in patients with TD.     

The associations between epilepsy and depressive illness in secondary care.

BACKGROUND: The association between epilepsy and depressive illness has long been established. However, though various explanations-psychosocial and anatomical-have been proposed findings from studies are inconsistent and often contradictory. AIMS: This study aimed to compare the features of those people with epilepsy seen in a secondary care setting who developed a depressive illness with those that did not. METHOD: Information regarding the patient's epilepsy, history and presence of depressive illness and perceived social functioning was gathered from case notes, questionnaire and patient interview. RESULTS: The experience of a depressive episode was associated with the presence of a right-sided lesion, attacks occurring more than once each month, diagnosis made in adulthood and a perceived marked effect of the epilepsy on mobility and social activity. CONCLUSION: These findings are not all consistent with work already carried out in this field. However, they do point to a multifactorial aetiology of depressive illness in this group as is the case in the general population. Possible explanations for frequently contradictory findings are discussed.     

Brief report: Testing measurement invariance and differences in self-concept between adolescents with and without physical illness or developmental disability

The aim of this study was to test for measurement invariance and examine differences in global self-concept between adolescents with and without physical illness or developmental disability. The sample consisted of adolescents 10–19 years who participated in the Canadian National Longitudinal Survey of Children and Youth (N = 8491). Multiple group confirmatory factor analysis was used to test for measurement invariance. Twenty-three percent (n = 1966) of participants had a physical illness or developmental disability. Support was found for strict measurement invariance between groups suggesting adolescents in both groups perceived items similarly, indicating that comparisons between adolescents with and without physical illness or developmental disability are meaningful. Controlling for several sociodemographic characteristics, evidence suggested that self-concept is lower in adolescents with physical illness or developmental disability, β = −0.24, p = 0.0005, compared to their healthy peers. Future work should attempt to understand the processes leading to compromised self-concept in adolescents with physical illness or developmental disability.     

The relationship of suicide rates to sociodemographic factors in Canadian census divisions.

The correlates of suicide rates were determined by conducting a multivariate study of sociodemographic indicators and suicide rates of 261 Canadian census divisions. Twenty-one sociodemographic variables were entered into a stepwise multiple linear regression to develop a model for suicide rates. The important variables were mortality rate for all causes of death, the age of the population, average family income, population density, proportion with no religious affiliation, proportion of Francophones, unemployment, immigration, proportion of Native people, a regional effect for British Columbia and the north, and growth by mobility, explaining 62% of the observed variation. This spatial ecologic analysis highlights the importance of cultural differences in explaining the variation of suicide rates. The analysis supports the previously found negative relationship between income and suicide while contrasting from previous studies in determining a inverse relationship with unemployment and an inverse relationship with the age distribution.     

Heritable factors in the severity of affective illness.

A review of clinical experience with 163 patients with primary affective disorder indicates that patients with a history characterized by recurrent depression interspersed with periods of hypomania (bipolar II) may have clinical courses that are distinguishable from bipolar I (depression with histories of mania) or unipolar patients. A prior history of suicide attempt and suicide after discharge from the research unit were most frequent among bipolar II patients. The family histories of bipolar I and bipolar II patients revealed similarly increased morbid risks for bipolar illness, whereas no bipolar illness was found in the first-degree relatives of unipolar patients. The suggestion that patients classified as bipolar II be separately considered in future studies of affective disorder is discussed.     

The relationship between memory performance, perceived cognitive function, and mood in patients with epilepsy.

OBJECTIVE: The low correlations between memory performance and subjective memory may be attributable to disparities between tasks in neuropsychological tests and cognitive experiences of day-to-day living. This study evaluated the relationship between everyday memory performance, perceived cognitive functioning, and mood among patients with epilepsy. METHODS: From three epilepsy centers in the USA, 138 patients were recruited. Everyday memory performance was measured using the Rivermead Behavioural Memory Test (RBMT). Questionnaires assessed perceived cognitive function (cognitive domain, Quality of Life in Epilepsy Inventory, QOLIE-89) and mood (Profile of Mood States, POMS). RESULTS: Memory performance scores were weakly correlated with perceived cognitive functioning (r =0.22, P < 0.01). Perceived cognitive functioning was strongly correlated with mood (r = - 0.75, P < 0.0001). Multiple regression analysis indicated memory performance (RBMT) and mood (POMS) were independent predictors of perceived cognitive functioning (P < 0.02); however, the explained variance for RBMT and POMS combined (R2 = 0.58) is only slightly higher than the predictive value for the POMS score alone (R2 = 0.56). CONCLUSIONS: Memory performance tests provide qualitatively different information than patients' self-reported cognitive difficulties, thus it is important to assess memory performance, perceived cognitive function, and mood separately because the constructs are related but not redundant.     

Social network among people with persistent mental illness: associations with sociodemographic, clinical and health-related factors

BACKGROUND: Social interaction is crucial for whether a person will successfully accomplish important life tasks. AIM AND METHOD: This study investigated the importance of sociodemographic, clinical and self-perceived health-related factors for social interaction among 103 individuals with persistent mental illness, mainly psychoses, visiting an outpatient unit. RESULTS: Bivariate analyses pointed to several relationships, especially between the health-related variables and both quantitative and qualitative aspects of the social network. In multivariate analyses, higher levels of quality of life, self-esteem, being a cohabitant, and living in a house were related to higher ratings on different aspects of the social network. Older age was associated with fewer close relationships but more adequate social integration. CONCLUSIONS: The social network appeared to be a function of both self-perceptions and sociodemographic influences. The influence is probably dynamic and, for example, just as a better quality of life may lead to more social interaction, a more developed social network probably promotes better quality of life. Therefore, interventions in mental health care that target social interaction constitute a powerful resource and should be part of the support for people with severe and persistent mental illness.     

The relationship between sleep and epilepsy

The occurrence of seizures in the sleep state is observed in nearly one third of patients. This is caused by an intimate relationship between the physiological state of sleep and the pathological process underlying epileptic seizures. Both sleep and sleep deprivation influence the frequency of epileptiform discharges on electroencephalograms as well as the occurrence of clinical seizures, typically during nonrapid eye movement sleep. The relationship of epileptiform activity to nonrapid eye movement sleep is vividly shown in the syndrome of continuous spikes in slow-wave sleep and the Landau-Kleffner syndrome. Seizure semiology can also be influenced by sleep and sleep deprivation. Sleep disorders may influence seizure control, and effective treatment of sleep disorders can improve seizure control. Seizures, antiepileptic drugs, ketogenic diet, and vagus nerve stimulation all influence sleep quality, daytime alertness, and neurocognitive function.     

The relationship between sleep and epilepsy

Seizures occur extensively during sleep or on awakening in a substantial proportion of patients with epilepsy. Interictal epileptiform discharges are also influenced by sleep and sleep deprivation. Continuous spike-waves in slow-wave sleep are the hallmark of Landau-Kleffner syndrome and ESES (Electrical Status in Slow Sleep). Sleep deprivation is known to influence not only the occurrence but also the symptomatology of epileptic seizures. Sleep architecture and daytime alertness are influenced by seizures and antiepileptic medications. This review examines the clinical and basic science aspects of this relationship between sleep and epilepsy.     

The relationship between self-esteem and psychiatric disorders in adolescents.

OBJECTIVE: To examine the relationship between self-esteem and psychiatric disorders in adolescents. METHODS: Seventy-six adolescents (mean age: 16.02 years; range: 12-20) treated in an inpatient unit and presenting with DSM-IV psychotic disorder, depressive disorder, anxious disorder, anorexia nervosa, personality disorder, or conduct disorder were compared with a control group of 119 adolescents drawn from a normal population. All the subjects were assessed with the French translation of the Coopersmith self-esteem inventory (SEI). RESULTS: Self-esteem was significantly higher in the control than in the clinical population (P = 0.0001). Female patients showed significantly lower SEI scores than male patients. Self-esteem increased significantly after 12 weeks in patients with a first psychotic episode who responded successfully to antipsychotic drug treatment. In the clinical group, a history of suicide attempts and sexual abuse was associated with significantly lower SEI scores. Lack of boy- or girlfriend, dropping out of school, and social withdrawal were also associated with lower self-esteem. CONCLUSION: The presence of a psychiatric disorder in adolescents is associated with decreased self-esteem. This decrease in self-esteem varies according to the psychiatric disorder. Appropriate treatment can enhance self-esteem in adolescent patients.     

The relationship between posttraumatic stress disorder, illness cognitions, defence styles, fatigue severity and psychological well-being in chronic fatigue syndrome

This study investigated, firstly, the rate of posttraumatic stress disorder (PTSD) and the level of psychological well-being amongst people with chronic fatigue syndrome (CFS); and secondly, the extent to which illness cognitions, defence styles and PTSD symptom severity related to fatigue severity and psychological well-being. Seventy-eight participants with a diagnosis of CFS completed the Chalder Fatigue Scale, the General Health Questionnaire-28, the Posttraumatic Stress Diagnostic Scale, the Illness Cognition Questionnaire and the Defence Style Questionnaire. Fifty-nine participants were recruited from the general public to form the non-fatigued control group. CFS participants had significantly higher levels of PTSD symptoms, lower levels of psychological well-being and more traumatic life events compared to the non-fatigued controls. Trauma exposure and PTSD severity both predicted CFS status. However, regression analyses demonstrated no significant relationship between PTSD symptoms and fatigue severity or the degree of psychological well-being. ‘Helplessness’ predicted both physical and mental fatigue and psychological well-being, whilst the ‘mature’ defence styles predicted fatigue severity only. The results offer support to previous research showing that the rate of traumatic life events and PTSD are significantly higher amongst the CFS population. The lack of relationship between PTSD symptoms and fatigue severity or psychological well-being indicates that these processes may operate independently of one another, via different appraisal processes. This study focused on fatigue severity, but it may be that the role of pain in CFS is a key element in the previously reported association between PTSD and CFS.     

The associations between epilepsy and depressive illness in secondary care

BACKGROUND: The association between epilepsy and depressive illness has long been established. However, though various explanations-psychosocial and anatomical-have been proposed findings from studies are inconsistent and often contradictory.AIMS: This study aimed to compare the features of those people with epilepsy seen in a secondary care setting who developed a depressive illness with those that did not.METHOD: Information regarding the patient's epilepsy, history and presence of depressive illness and perceived social functioning was gathered from case notes, questionnaire and patient interview.RESULTS: The experience of a depressive episode was associated with the presence of a right sided lesion, attacks occurring more than once each month, diagnosis made in adulthood and a perceived marked effect of the epilepsy on mobility and social activity.CONCLUSION: These findings are not all consistent with work already carried out in this field. However, they do point to a multifactorial aetiology of depressive illness in this group as is the case in the general population. Possible explanations for frequently contradictory findings are discussed.     

The relationship between insight and social skill in persons with severe mental illness.

The relationship of insight with the social behaviors of outpatients with severe mental illness (SMI) was investigated. Participants' engaged in two social interactions (i.e., stigmatizing and nonstigmatizing), each with a different research confederate. The participant's behavior was later coded for the presence of various self-presentation and social skill variables. Results indicated that greater insight was associated with better overall social skill, less observed strangeness, and greater self-disclosure of one's mental illness. Furthermore, the three measures of insight, one based on self-report and two interview-based, were all highly intercorrelated, suggesting that they are measuring a similar construct. Finally, consistent with previous research in the area, greater insight was associated with less severe psychiatric symptoms. Implications of these findings for future research are discussed.     

Elucidating the relationship between negative affectivity and symptoms: The role of illness-specific affective responses

Background: More than 20 years of research confirm a positive association of trait negative affect (NA) with reports of physical symptoms. As the mechanisms underlying the association of trait NA and symptom reporting have not been identified, the meaning of the association remains unclear.Purpose: We attempted to clarify the processes underlying this association by examining the relationship of trait NA and illness-specific worry to both vague, general symptoms and illness-specific symptoms. We tested the hypothesis that trait NA has both a “biasing” effect when ambiguous symptoms are interpreted as a sign of physical illness and an “accuracy” effect on the reports of illness-specific symptoms mediated by illness-specific worry.Method: We examined the relationship of trait and state NA to symptoms reports in both cross-sectional and longitudinal data from inner-city adults with moderate and severe asthma.Results: Whereas high levels of trait NA were associated with reports of both asthma and nonasthma symptoms, only the relationship of trait NA to symptoms specific to asthma was mediated by asthma worry. In addition, these data showed that trait NA was not associated with the misattribution of symptoms to disease.Conclusions: We concluded that NA motivates individuals, through asthma worry, to be more aware of illness-specific symptoms and correctly report and attribute these symptoms to asthma. This study was funded by the Agency for Healthcare Research and Quality (RO1 HS09973) and the United Hospital Fund (010608B). Pablo A. Mora and Howard Leventhal were assisted by grant NIA AG023958 during the writing of this article. Ethan Halm was also supported by the Robert Wood Johnson Foundation Generalist Physician Faculty Scholars Program. Portions of this study were based on Pablo A. Mora’s doctoral dissertation.     

性激素与癫痫

癫痫患者体内的性激素的水平与正常人不同,其癫痫发作与性激素水平有关。性激素、癫痫以及抗癫痫药物之间 相互影响。雌激素受体调节剂-克罗米酚以及天然或者合成的孕激素对一些癫痫患者的发作有效。     

The relationship between self-esteem and psychological adjustment in young adolescents.

The study adopts a multi-dimensional construct of self-esteem to examine the relationship between self-perception and psychological adjustment in order to identify specific dimensions that discriminate between disturbed and non-disturbed groups. The disturbed group (n = 33) is derived from a clinical sample and are matched with a non-disturbed group (n = 33) of adolescents. Results indicate that dimensional self-concept scores are significantly lower for clinical subjects while there are no significant differences between groups on the mathematics, honesty, and physical ability dimensions. These findings provide a more fine grained understanding of the relationship between self-esteem and psychological adjustment and emphasize the need to examine self-esteem in terms of its particular dimensions.